In preparation for the Affordable Care Act's latest enrollment season, the Trump administration sent notices about the sign-up options to millions fewer Americans than in past years and deleted themes known to be most effective in motivating consumers to sign up.

Emails went in advance only to people with current health-care plans through marketplaces created under the law, leaving out most of the names in a database of about 20 million consumers who once had such coverage or at some point explored the federal website HealthCare.gov.

The greatly reduced outreach is reflected in a set of internal documents obtained by The Washington Post, which also shows a sharp change in the tone and content of the messaging ahead of Wednesday's sign-up start.

For example, a Nov. 1, 2016, email to current enrollees about the start of that sign-up period said: "New, better or more affordable plans may be available to you. . . . You could save money by switching to a new plan." It urged consumers to "find the coverage that best meets your needs and budget."

A parallel notice emailed late last week removed any mention of affordability, potential money savings or shopping for other health-care plans. Instead, it simply listed the enrollment season's start and end dates, telling recipients that this year's period is shorter and that they "can confirm, change or update" a plan.

The unannounced changes in emails are the latest manifestation of a multi-pronged effort by the Trump administration to undercut the insurance exchanges created by the 2010 law that the president remains eager to repeal. The cutback in communication and content coincides with federal health officials' move in late August to slash government spending on advertising and other outreach strategies for the ACA marketplaces by 90 percent — from $100 million to $10 million.

Yet the changes run counter to a recent government document that lays out a "consumer timeline" for current and new customers to the insurance exchanges and identifies October and November as "ideal time for widespread outreach and education efforts."

And a summary of this year's enrollment-related activities, issued just a week ago by the Health and Human Services Department's Centers for Medicare and Medicaid Services, says that "targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers multiple emails per week, with increasing frequency as the deadline approaches."

With sign-ups officially underway, emails now will be sent to all former marketplace customers, according to an individual familiar with the schedule, who spoke on the condition of anonymity about internal discussions.

A separate document, which details the plans for emails to existing customers and compares them with the previous enrollment season's, shows that this year's notices will be sparser and not targeted to as specific niches of consumers.

In addition, lower-income customers will not be informed that they are probably eligible for the ACA's "cost-sharing-reduction" subsidies, government help for their deductibles and other out-of-pocket costs. "We will use a generic financial help message that doesn't specifically speak to CSRs," according to a comment section in the document, which appears to have been written before Trump last month abruptly ended those payments to reimburse insurers required to provide the subsidies.

The modified content overall essentially jettisons the findings from extensive research that health officials and federal contractors conducted during the Obama administration to determine which messages were most potent in prompting consumers to shop for and buy ACA coverage.

In focus groups, surveys and randomized trials comparing the effectiveness of various wording, the messages about health plans' affordability proved the most powerful, according to Josh Peck, who worked at CMS during the previous administration as chief marketing officer for the federal exchange.

"Every lick of research CMS has done shows the number one concern consumers is cost," agreed Lori Lodes, former director of that agency's office of communications. By not mentioning that people are likely to qualify for subsidies that can help them afford a health plan, the email "guts the impact of that outreach," she said.

CMS officials did not dispute the change in tone and theme but said that at least three to five emails will be sent weekly to consumers during the sign-up period and that they will provide information about steps they can take. "The emails encourage potential consumers to shop around for the plan that best meets their needs," an agency spokesman said late Wednesday.

Amy GoldsteinAmy Goldstein is The Washington Post’s national health-care policy writer. During her 30 years at The Post, her stories have taken her from homeless shelters to Air Force One, often focused on the intersection of politics and public policy. She is the author of the book "Janesville: An American Story." Follow

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